Clinical and Radiological Results after Endoscopic Treatment for Gluteal Tendon Injuries with a Minimum Follow-Up of 12 Months

Document Type : RESEARCH PAPER


1 Departamento de Ortopedia, Instituto Vita, São Paulo, SP, Brazil

2 Departamento de Radiologia Musculoesquelética, Fleury Medicina e Saúde, São Paulo, SP, Brazil


Objectives: The study aimed to evaluate the clinical and radiological results after endoscopic repair of 
gluteus medius muscle injuries and proposed an anatomical classification for the different injury 
Methods: A retrospective case series, including patients who had undergone endoscopic repair of the hip abductor 
tendon. The surgical procedure was standardized. Magnetic resonance imaging (MRI) studies were analyzed, and 
the injuries were classified into three types: nontransfixing partial-extension (nTPE) tear, transfixing partial-extension 
(TPE) tear, and transfixing full-extension (TFE) tear. TPE and TFE were considered high-grade tears. The 
postoperative outcomes were as follows: duration of walking aid requirement, duration of physical therapy, time to 
return to daily activities, modified Harris Hip score (mHHS) and Nonarthritic Hip Score (NAHS) functional scores, 
pain visual analog scale (VAS), satisfaction, claudication, Trendelenburg test, and reoperation.
Results: Sixteen patients were included (94% women; mean age 65 years), with a mean follow-up of 42 months 
(12-131, range). Out of the cases with preoperative exams available for analysis, four cases (31%) were nTPE, 
three (23%) TPE, and six (46%) TFE tears. Thus, 69% of the patients had high-grade injuries. These patients had 
a higher degree of fat infiltration (P = 0.034), but this was not correlated with inferior postoperative clinical or 
radiological results. One patient required reoperation due to a recurrent injury.
Conclusion: Isolated extra-articular injuries to the tendons of the gluteus medius and minimus evolved satisfactorily 
after endoscopic repair. Due to the small number of cases, it was not possible to observe differences in outcomes 
between high-and low-grade injuries.
 Level of evidence: IV


Main Subjects

  1. Zhu MF, Musson DS, Cornish J, Young SW, Munro JT. Hip abductor tendon tears: where are we now? Hip Int. 2020; 30(5):500-512. doi: 10.1177/1120700020922522.
  2. Voos JE, Rudzki JR, Shindle MK, Martin H, Kelly BT. Arthroscopic Anatomy and Surgical Techniques for Peritrochanteric Space Disorders in the Hip. Arthroscopy.2007; 23(11):1246.e1-5. doi: 10.1016/j.arthro.2006.12.014.
  3. Coulomb R, Essig J, Mares O, Asencio G, Kouyoumdjian P, May O. Clinical results of endoscopic treatment without repair for partial thickness gluteal tears. Orthop Traumatol Surg Res. 2016; 102(3):391-5. doi:10.1016/J.OTSR.2016.01.007.
  4. Hartigan DE, Perets I, Ho SW, Walsh JP, Yuen LC, Domb BG. Endoscopic Repair of Partial-Thickness Undersurface Tears of the Abductor Tendon: Clinical Outcomes with Minimum 2-Year Follow-up. Arthroscopy. 2018; 34(4):1193-1199. doi:10.1016/j.arthro.2017.10.022.
  5. D'Addona A, Rocca F Della, Carrella D, et al. Effectiveness of endoscopic trans-tendineous repair for partial-thickness tears of medius gluteus: A systematic review of literature. J Hum Sport Exerc. 2020; 15:S770-S780. doi:10.14198/jhse.2020.15.Proc3.27.
  6. Lübbeke A, Kampfen S, Stern R, Hoffmeyer P. Results of surgical repair of abductor avulsion after primary total hip arthroplasty. J Arthroplasty. 2008; 23(5):694-8. doi:10.1016/j.arth.2007.08.018.
  7. Domb BG, Botser I, Giordano BD. Outcomes of endoscopic gluteus medius repair with minimum 2-year follow-up. Am J Sports Med. 2013; 41(5):988-97. doi: 10.1177/0363546513481575.
  8. Makridis KG, Lequesne M, Bard H, Djian P.Clinical and MRI results in 67 patients operated for gluteus medius and minimus tendon tears with a median follow-up of 4.6 years. Orthop Traumatol Surg Res. 2014; 100(8):849-53. doi:10.1016/j.otsr.2014.08.004.
  9. Chandrasekaran S, Gui C, Hutchinson MR, Lodhia P, Suarez-Ahedo C, Domb BG. Outcomes of Endoscopic Gluteus Medius Repair: Study of Thirty-four Patients with Minimum Two-Year Follow-up. J Bone Joint Surg Am. 2015; 97(16):1340-7. doi:10.2106/JBJS.N.01229.
  10. Kirby D, Fried JW, Bloom DA, Buchalter D, Youm T. Clinical Outcomes after Endoscopic Repair of Gluteus Medius Tendon Tear Using a Knotless Technique with a 2-Year Minimum Follow-Up. Arthroscopy. 2020; 36(11):2849-55. doi:10.1016/j.arthro.2020.07.022.
  11. Nazal MR, Abraham PF, Conaway WK, et al. Endoscopic Repair of Full-Thickness Gluteus Medius and Minimus Tears-Prospective Study with a Minimum 2-Year Follow-Up. Arthroscopy. 2020; 36(8):2160-9. doi:10.1016/j.arthro.2020.04.025.
  12. Perets I, Mansor Y, Yuen LC, Chen AW, Chaharbakhshi EO, Domb BG.. Endoscopic Gluteus Medius Repair with Concomitant Arthroscopy for Labral Tears: A Case Series with Minimum 5-Year Outcomes. Arthroscopy. 2017; 33(12):2159-67. doi:10.1016/j.arthro.2017.06.032.
  13. Chandrasekaran S, Lodhia P, Gui C, Vemula SP, Martin TJ, Domb BG. Outcomes of Open Versus Endoscopic Repair of Abductor Muscle Tears of the Hip: A Systematic Review. Arthroscopy. 2015; 31(10):2057-67. doi:10.1016/j.arthro.2015.03.042.
  14. Maslaris A, Vail TP, Zhang AL, Patel R, Jäger M, Bini SA. Equivalent Mid-Term Results of Open vs Endoscopic Gluteal Tendon Tear Repair Using Suture Anchors in Forty-Five Patients. J Arthroplasty. 2020; 35(6):S352-8. doi:10.1016/j.arth.2020.03.013.
  15. Domb BG, Nasser RM, Botser IB. Partial-thickness tears of the gluteus medius: rationale and technique for trans-tendinous endoscopic repair. Arthroscopy. 2010; 26(12):1697-705. doi:10.1016/j.arthro.2010.06.002.
  16. Bunker TD, Esler CN, Leach WJ. Rotator-cuff tear of the hip. J Bone Joint Surg Br. 1997; 79(4):618-20. doi: 10.1302/0301-620x.79b4.7033.
  17. Kegan 2nd A. Rotator cuff tears of the hip. Clin Orthop Relat Res. 1999; 368:135-40.
  18. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994(304):78-83.
  19. Gerber C, Schneeberger AG, Hoppeler H, Meyer DC. Correlation of atrophy and fatty infiltration on strength and integrity of rotator cuff repairs: a study in thirteen patients. J shoulder Elb Surg. 2007; 16(6):691-6. doi:10.1016/j.jse.2007.02.122.
  20. Engelken F, Wassilew GI, Köhlitz T, Brockhaus S, Hamm B, Perka C. Assessment of Fatty Degeneration of the Gluteal Muscles in Patients With THA Using MRI: Reliability and Accuracy of the Goutallier and Quartile Classification Systems. J Arthroplasty. 2014; 29(1):149-53. doi:10.1016/j.arth.2013.04.045.
  21. Bogunovic L, Lee SX, Haro MS, et al. Application of the Goutallier/Fuchs Rotator Cuff Classification to the Evaluation of Hip Abductor Tendon Tears and the Clinical Correlation with Outcome after Repair. Arthrosc J Arthrosc Relat Surg. 2015; 31(11):2145-51. doi:10.1016/j.arthro.2015.04.101.
  22. Thaunat M, Clowez G, Desseaux A, et al. Influence of Muscle Fatty Degeneration on Functional Outcomes after Endoscopic Gluteus Medius Repair. Arthroscopy. 2018; 34(6):1816-24. doi:10.1016/j.arthro.2018.01.005.
  23. Ochiai D. Editorial Commentary: Treatment of Partial Thickness Undersurface Abductor Tears of the Hip: Like Backwards a Bike Riding. Arthroscopy. 2018; 34(4):1200-1. doi:10.1016/j.arthro.2017.11.024.
  24. Lubowitz JH, Brand JC, Rossi MJ. Hip Gluteus Medius and Minimus Endoscopic Treatment Results in Patient Satisfaction. Arthroscopy. 2020; 36(11):2775-6. doi:10.1016/j.arthro.2020.09.030.
  25. Nho SJ, Grzybowski JS, Bogunovic L, et al. Diagnosis, Evaluation, and Endoscopic Repair of Partial Articular Gluteus Tendon Avulsion. Arthrosc Tech. 2016; 5(3):e425-31. doi:10.1016/j.eats.2016.01.023.
  26. Gerber C, Meyer DC, Frey E, et al. Neer Award 2007: Reversion of structural muscle changes caused by chronic rotator cuff tears using continuous musculotendinous traction. An experimental study in sheep. J shoulder Elb Surg. 2009; 18(2):163-71. doi:10.1016/j.jse.2008.09.003.
  27. Chaudhury S, Dines JS, Delos D, Warren RF, Voigt C, Rodeo SA. Role of fatty infiltration in the pathophysiology and outcomes of rotator cuff tears. Arthritis Care Res (Hoboken). 2012; 64(1):76-82. doi:10.1002/acr.20552.
  28. Kuzel BR, Grindel S, Papandrea R, Ziegler D. Fatty infiltration and rotator cuff atrophy. J Am Acad Orthop Surg. 2013; 21(10):613-23. doi: 10.5435/jaaos-21-10-613.
  29. Melis B, Nemoz C, Walch G. Muscle fatty infiltration in rotator cuff tears: descriptive analysis of 1688 cases. Orthop Traumatol Surg Res. 2009; 95(5):319-24. doi:10.1016/j.otsr.2009.05.001.
  30. Busse J, Gasteiger W, Tönnis D. [A new method for roentgenologic evaluation of the hip joint--the hip factor]. Arch Orthop Unfallchir. 1972; 72(1):1-9. doi: 10.1007/BF00415854.
  31. Kenanidis E, Kyriakopoulos G, Kaila R, Christofilopoulos P. Lesions of the abductors in the hip. EFORT open Rev. 2020; 5(8):464-76. doi:10.1302/2058-5241.5.190094.